| NPI | 1861004129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL D25008) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901600636) |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2023-07-11 |