| NPI | 1528470283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CT 11865) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 7249-15) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2023-03-09 |