NPI | 1144420233 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO 202780) |
Additional Taxonomies | 122300000X Dentist (Licence: TX 0023429) |
Enumeration Date | 2007-07-18 |
Last Update Date | 2019-05-02 |