| NPI | 1700937406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA DN122926) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CT 7788) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2024-05-22 |