| NPI | 1548616238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA DN015915) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 059402) |
| 122300000X Dentist (Licence: GA DN015915) | |
| 122300000X Dentist (Licence: IL 019.030235) | |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2020-08-06 |