| NPI | 1093947558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VA 0401413532) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS036994) |
| 1223E0200X Dentist, Endodontics (Licence: CA 58086) | |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2013-01-06 |