| NPI | 1578769139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: FL DN17539) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN17539) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2015-06-03 |