| NPI | 1962580472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D008343) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MN D10716) |
| 1223E0200X Dentist, Endodontics (Licence: NM DD2828) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2025-12-19 |