| NPI | 1457589335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA DN013945) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: FL DN17864) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2021-05-18 |