| NPI | 1184177560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN22214) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN22214) |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2019-10-30 |