| NPI | 1760498422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN14230) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN14230) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2019-04-26 |