| NPI | 1699269084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 12146) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 0401418844) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2026-07-22 |