| NPI | 1447333414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: WI 5120015) |
| Additional Taxonomies | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: WI 5120015) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2022-07-21 |