NPI | 1942447776 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: WA DE60471062) |
Additional Taxonomies | 122300000X Dentist (Licence: OR D10185) |
122300000X Dentist (Licence: CA 57218) | |
1223E0200X Dentist Endodontics (Licence: MN S55) | |
Enumeration Date | 2009-01-15 |
Last Update Date | 2016-12-12 |