| NPI | 1245783430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: IA DDS-09490) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR D10504) |
| Enumeration Date | 2016-07-25 |
| Last Update Date | 2022-06-02 |