| NPI | 1801201421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: DC DEN1002230) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MD 17383) |
| 1223G0001X Dentist, General Practice (Licence: RI DEN03264) | |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2021-09-08 |