| NPI | 1912452392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 10374) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 10374) |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2023-06-14 |