| NPI | 1518459312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 12555) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 675) |
| 1223G0001X Dentist, General Practice (Licence: NC 12555) | |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2024-06-04 |