| NPI | 1982013116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OR D11462) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 9039273-9922) |
| Enumeration Date | 2014-08-13 |
| Last Update Date | 2021-10-25 |