| NPI | 1770898488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ 8016) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: KY 8995) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2016-02-04 |