| NPI | 1205063047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 8763) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 8763) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2022-07-21 |