NPI | 1154573020 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO 00203031) |
Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: VA 0401414520) |
122300000X Dentist (Licence: CA 57734) | |
1223E0200X Dentist, Endodontics (Licence: CA 57734) | |
Enumeration Date | 2008-10-22 |
Last Update Date | 2017-05-04 |