| NPI | 1215224738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8212) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: SC 817) |
| 122300000X Dentist (Licence: SC 8212) | |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2023-08-29 |