| NPI | 1255475117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NV S7-55) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NV 5491) |
| 1223E0200X Dentist, Endodontics (Licence: ID D-4207-EN) | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2022-10-18 |