| NPI | 1013923903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VA 0401411494) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 49162) |
| 1223E0200X Dentist, Endodontics (Licence: MD 13212) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-09-17 |