NPI | 1972247591 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IL 019.033702) |
Additional Taxonomies | 122300000X Dentist (Licence: IL 019.033702) |
Enumeration Date | 2022-04-21 |
Last Update Date | 2022-08-29 |