| NPI | 1992105951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NV S7-91) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1000987-15) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2016-06-27 |