| NPI | 1578795126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D008528) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MN D14119) |
| 1223E0200X Dentist, Endodontics (Licence: CA 61072) | |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2021-12-20 |