| NPI | 1356508931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NM DD2993) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: VA 0401411226) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2021-03-30 |