| NPI | 1932586856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OR 11039) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 15837) |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2022-10-05 |