| NPI | 1013140706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SC 10470) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 7750) |
| 1223G0001X Dentist, General Practice (Licence: AZ D07750) | |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2023-06-09 |