| NPI | 1275777849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: LA 5699) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 5699) |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2023-12-05 |