NPI | 1639481849 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: NC 6544) |
Additional Taxonomies | 122300000X Dentist (Licence: NC 8987) |
1223E0200X Dentist Endodontics (Licence: NC 6544) | |
Enumeration Date | 2010-07-06 |
Last Update Date | 2022-03-28 |