| NPI | 1417182916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MD 15392) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WV 3860) |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2021-11-07 |