| NPI | 1700401577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MO 2020013626) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2020013626) |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2020-07-08 |