| NPI | 1598262263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: MO 2020012407) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WI 1001820-15) |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2021-08-03 |