| NPI | 1174557565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA DN013753) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CT 5113) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2014-08-27 |