| NPI | 1104106996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D011401) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D-4388) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2022-06-13 |