| NPI | 1518214832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MO 2016021018) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 8101) |
| 1223G0001X Dentist, General Practice (Licence: NC 9101) | |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2022-07-29 |