| NPI | 1205806411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NC 10456) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AZ D5925) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2023-03-07 |