NPI | 1598852188 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: MT 4131) |
Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: OR D9248) |
1223G0001X Dentist General Practice (Licence: TX 22555) | |
Enumeration Date | 2006-10-06 |
Last Update Date | 2019-02-27 |