| NPI | 1811301625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN24570) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MA DN1856948) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2022-03-11 |