| NPI | 1033468269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO DEN.00205893) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019029151) |
| 1223E0200X Dentist, Endodontics (Licence: IL 019029151) | |
| 1223E0200X Dentist, Endodontics (Licence: MS 4250-21) | |
| Enumeration Date | 2012-09-04 |
| Last Update Date | 2026-04-20 |