NPI | 1508045410 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: MA DN1855033) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CT 9677) |
Enumeration Date | 2007-10-26 |
Last Update Date | 2023-06-21 |