| NPI | 1841502515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA DN014541) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 4713) |
| Enumeration Date | 2010-07-09 |
| Last Update Date | 2013-08-13 |