NPI | 1316341613 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NV s7-118c) |
Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 39171) |
122300000X Dentist (Licence: UT 90437479922) | |
122300000X Dentist (Licence: VA 0442000373) | |
Enumeration Date | 2014-10-15 |
Last Update Date | 2023-10-23 |