| NPI | 1588222939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: SC 10619) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NC 11392) |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2024-02-21 |