NPI | 1528415742 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: KY 10740) |
Additional Taxonomies | 122300000X Dentist (Licence: MN D13666) |
122300000X Dentist (Licence: KY 10740) | |
Enumeration Date | 2016-05-17 |
Last Update Date | 2023-10-03 |