| NPI | 1154554178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 9131) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 9131) |
| 122300000X Dentist (Licence: VA 0442000101) | |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2022-03-28 |