| NPI | 1962621151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: KY 7518) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: CO 8403) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2022-10-10 |