| NPI | 1336712496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 12412) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 12412) |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2024-03-06 |