| NPI | 1144292830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WI 6081-015) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MN D11471) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2008-03-24 |