| NPI | 1194073593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN27683) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL D.0005920) |
| 1223E0200X Dentist, Endodontics (Licence: NY 061706) | |
| 1223E0200X Dentist, Endodontics (Licence: MO 2018029180) | |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2023-08-04 |