| NPI | 1659711794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 9770) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC 9770) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2026-07-22 |