| NPI | 1235512781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN21378) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 21378) |
| 122300000X Dentist (Licence: MD 16001) | |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2022-02-15 |