NPI | 1255077582 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WI 6001349-15) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1859345) |
1223E0200X Dentist, Endodontics (Licence: MA DN1859345) | |
Enumeration Date | 2022-05-10 |
Last Update Date | 2025-07-21 |