| NPI | 1205045382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SC 4305) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: GA DN013507) |
| 1223E0200X Dentist, Endodontics (Licence: NY 50-051910) | |
| 1223E0200X Dentist, Endodontics (Licence: WV 3516) | |
| 1223E0200X Dentist, Endodontics (Licence: VA 0401411675) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-10-09 |