| NPI | 1003916826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: MS 3405-06) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NC 150563) |
| 1223G0001X Dentist General Practice (Licence: AL 106) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2015-07-28 |