| NPI | 1487940201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL 19374) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN19374) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2023-10-23 |