| NPI | 1528580560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: FL DN22584) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN22584) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2020-06-19 |