NPI | 1245215359 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MO 2009006811) |
Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 33452) |
1223E0200X Dentist, Endodontics (Licence: KS 656) | |
Enumeration Date | 2005-12-12 |
Last Update Date | 2011-02-03 |