| NPI | 1417443276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DRPM2601) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD4933) |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2023-06-14 |