| NPI | 1457618571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA DN014445) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: FL DN21024) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2015-12-01 |