| NPI | 1013073568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL 17794) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MA 20256) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2018-06-20 |