NPI | 1851883763 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: LA 7393) |
Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857975) |
1223E0200X Dentist, Endodontics (Licence: CO DEN.00204361) | |
Enumeration Date | 2018-06-06 |
Last Update Date | 2023-01-30 |