| NPI | 1851883763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: LA 7393) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857975) |
| 1223E0200X Dentist, Endodontics (Licence: CO DEN.00204361) | |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2023-01-30 |