| NPI | 1497914345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CT 12855) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 10363) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2020-09-23 |