| NPI | 1306220652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OR D11303) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ in process) |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2023-04-19 |