| NPI | 1396126157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SC 10301) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 8557) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2024-04-26 |