| NPI | 1073648754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ 7512) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 21734) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2009-04-27 |