| NPI | 1245217447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: MD 13964) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 21059) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2022-07-05 |