NPI | 1295902849 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CT 4956) |
Additional Taxonomies | 122300000X Dentist (Licence: CT 4956Dentist) |
Enumeration Date | 2008-05-13 |
Last Update Date | 2015-01-07 |