| NPI | 1619406451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 13351) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415638) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2023-08-03 |