| NPI | 1073780284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NC 11710) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: WV 3651) |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2021-04-08 |