| NPI | 1649350661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN17169) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: FL DN17169) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2017-06-20 |