| NPI | 1366858151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MD 15613) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401414343) |
| 1223G0001X Dentist, General Practice (Licence: MD 15613) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2019-07-08 |