| NPI | 1811251481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN 21302) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 15116) |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2017-12-04 |