| NPI | 1477663904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL 7102) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: FL DN7102) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2022-05-19 |