NPI | 1376036814 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 36044) |
Additional Taxonomies | 122300000X Dentist (Licence: MA DN1858057) |
1223E0200X Dentist, Endodontics (Licence: MA DN1858057) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2018-06-10 |
Last Update Date | 2021-08-09 |