| NPI | 1144420233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: CO 202780) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 0023429) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2019-05-02 |