| NPI | 1649610643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: KY 9344) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9344) |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2021-09-09 |