NPI | 1144584046 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 65343) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 244202) |
Enumeration Date | 2012-06-26 |
Last Update Date | 2024-10-29 |