| NPI | 1992017149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D7571) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 7571) |
| Enumeration Date | 2010-07-04 |
| Last Update Date | 2018-03-17 |