| NPI | 1194094938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL 19593) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 19593) |
| 122300000X Dentist (Licence: MI 2901021517) | |
| Enumeration Date | 2011-12-23 |
| Last Update Date | 2019-09-20 |