| NPI | 1881972974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WI 1001764) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038788) |
| 1223E0200X Dentist, Endodontics (Licence: OR D10265) | |
| 1223E0200X Dentist, Endodontics (Licence: VA 0401415405) | |
| Enumeration Date | 2011-07-24 |
| Last Update Date | 2018-05-25 |