| NPI | 1104812775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 5038) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: AZ 5038) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2021-11-02 |