NPI | 1548616238 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA DN015915) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 059402) |
122300000X Dentist (Licence: GA DN015915) | |
122300000X Dentist (Licence: IL 019.030235) | |
Enumeration Date | 2016-05-11 |
Last Update Date | 2020-08-06 |