NPI | 1679758304 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 28533) |
Additional Taxonomies | 122300000X Dentist (Licence: MA 21995) |
122300000X Dentist (Licence: NH 03639) | |
1223E0200X Dentist, Endodontics (Licence: CA 57686) | |
Enumeration Date | 2007-12-31 |
Last Update Date | 2019-09-04 |