| NPI | 1932558186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2016018486) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MO 2016018486) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2019-06-10 |