| NPI | 1043331861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: ND 2132) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-3962) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2014-05-28 |