| NPI | 1033366075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MT 2441) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MN D12284) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2011-09-06 |