| NPI | 1528212115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NM DD3284) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 22189) |
| Enumeration Date | 2008-11-09 |
| Last Update Date | 2021-05-12 |