| NPI | 1104987528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NV S7-45) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 45472) |
| 1223E0200X Dentist, Endodontics (Licence: AZ 7467) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2011-12-06 |