| NPI | 1609952878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN 9825) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WI 2925) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2016-09-20 |