| NPI | 1902284516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 150954) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NC 13605) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401414360) | |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2024-03-22 |