NPI | 1255313680 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OK 45) |
Additional Taxonomies | 122300000X Dentist (Licence: OK 5745) |
1223E0200X Dentist, Endodontics (Licence: UT 9074817) | |
Enumeration Date | 2005-11-21 |
Last Update Date | 2014-09-17 |