| NPI | 1649506213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN18826) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MA DN1855256) |
| Enumeration Date | 2009-11-02 |
| Last Update Date | 2017-02-20 |