| NPI | 1063403079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA DN014614) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 19662) |
| 1223E0200X Dentist, Endodontics (Licence: FL DN12265) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2023-04-13 |