| NPI | 1174086250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN24017) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: GA DN124059) |
| 1223E0200X Dentist, Endodontics (Licence: SC 11251) | |
| Enumeration Date | 2019-04-07 |
| Last Update Date | 2026-06-21 |