| NPI | 1588328793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN26493) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN26493) |
| Enumeration Date | 2021-10-25 |
| Last Update Date | 2026-06-30 |