| NPI | 1972713493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D4147) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 4147) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2018-09-10 |