| NPI | 1346687563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL 21608) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 28980) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2017-06-22 |