| NPI | 1205177185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 62035) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856090) |
| 122300000X Dentist (Licence: CA 62035) | |
| Enumeration Date | 2013-03-02 |
| Last Update Date | 2014-06-03 |