| NPI | 1255684916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SC 9688) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN19858) |
| 1223E0200X Dentist, Endodontics (Licence: DC DEN1001861) | |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2022-11-15 |