| NPI | 1609172329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 8708) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 8708) |
| Enumeration Date | 2011-01-27 |
| Last Update Date | 2023-06-15 |