NPI | 1942669312 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 103857) |
Additional Taxonomies | 122300000X Dentist (Licence: NY 059332-1) |
1223E0200X Dentist, Endodontics (Licence: CA DDS103857) | |
Enumeration Date | 2016-02-15 |
Last Update Date | 2019-07-16 |