| NPI | 1548523517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: DC DEN100513) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: MD 15124) |
| 1223E0200X Dentist Endodontics (Licence: FL 109649) | |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2018-07-13 |