| NPI | 1912127895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ 8884) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NV S7-64) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2021-10-14 |