| NPI | 1477743334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN 20216) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 23309) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2016-11-26 |