| NPI | 1104238120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NV S7-85) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: CA 62314) |
| Enumeration Date | 2014-05-25 |
| Last Update Date | 2021-11-21 |