| NPI | 1992854152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: MD 16727) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: CO 00203734) |
| 1223E0200X Dentist Endodontics (Licence: AR AR3387) | |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2019-03-05 |