| NPI | 1285127951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: AL 6500) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: FL DN27450) |
| 1223G0001X Dentist General Practice (Licence: AL 6500) | |
| 1223G0001X Dentist General Practice (Licence: TX 35040) | |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2022-10-13 |