| NPI | 1528024833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: LA 5540) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NC 7172) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2025-07-16 |