| NPI | 1588911861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SC 839 ENDO) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 8076) |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2018-01-02 |