| NPI | 1467643981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: WV 3779) |
| Additional Taxonomies | 122300000X Dentist (Licence: WV 3779) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2023-12-08 |