| NPI | 1497770218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL D19985) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: GA DN015767) |
| 1223E0200X Dentist, Endodontics (Licence: OH 30.025781) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2019-07-22 |