| NPI | 1497195549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN20224) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TN 11507) |
| 1223G0001X Dentist, General Practice (Licence: FL dn 20224) | |
| 1223G0001X Dentist, General Practice (Licence: SC dgd.8284 gd) | |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2021-04-12 |