NPI | 1386701373 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VA 0401416245) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 13352) |
1223E0200X Dentist, Endodontics (Licence: NY 055426) | |
Enumeration Date | 2007-01-02 |
Last Update Date | 2024-07-15 |