| NPI | 1154598175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 55666) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS037341) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2014-03-31 |