| NPI | 1588233712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 12222) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NC 12222) |
| Enumeration Date | 2021-06-22 |
| Last Update Date | 2021-06-22 |