| NPI | 1053457960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SC 784) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 4109) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2026-01-30 |