| NPI | 1134746738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN25420) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DRPM2189) |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2021-06-09 |