| NPI | 1639467780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN20783) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA dl11318) |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2015-08-13 |