| NPI | 1588915854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 12142) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 8360392-9921) |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2023-08-11 |