| NPI | 1285696724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NM DD2741) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: VA 0401006657) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2020-12-31 |