| NPI | 1063549392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: KY 4251) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 4251) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2021-01-05 |