| NPI | 1952896417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MN FJ8407795) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.031676) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2025-08-21 |