| NPI | 1154573020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: CO 00203031) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: VA 0401414520) |
| 122300000X Dentist (Licence: CA 57734) | |
| 1223E0200X Dentist Endodontics (Licence: CA 57734) | |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2017-05-04 |