| NPI | 1164494332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MO 13236) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: KS 6100) |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2013-02-08 |