| NPI | 1073513115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: MD 3804) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: DC 2275) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2007-07-08 |