| NPI | 1063870855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO DEN.00205684) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK 110831) |
| 1223E0200X Dentist, Endodontics (Licence: OH RES.004408) | |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2023-07-13 |