| NPI | 1174511844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: PR 1385) |
| Additional Taxonomies | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: PR 1385) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2013-06-04 |