NPI | 1922363126 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019.031342) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401413704) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2012-07-12 |
Last Update Date | 2018-08-02 |