| NPI | 1689082786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 31367) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: RI LD00103) |
| 122300000X Dentist (Licence: FL DN 21559) | |
| 1223E0200X Dentist, Endodontics (Licence: MN D14038) | |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2020-11-27 |