| NPI | 1174739361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN18422) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA ds035107) |
| 1223E0200X Dentist, Endodontics (Licence: NY 053268-1) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2009-06-04 |