| NPI | 1093909509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D07243) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA D6409) |
| 1223E0200X Dentist, Endodontics (Licence: NM DD4658) | |
| 1223G0001X Dentist, General Practice (Licence: AZ D07243) | |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2017-06-25 |