| NPI | 1013070879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: GA DNF000463) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: SC 3711) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2024-07-02 |