| NPI | 1245215359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: MO 2009006811) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: CA 33452) |
| 1223E0200X Dentist Endodontics (Licence: KS 656) | |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2011-02-03 |