| NPI | 1255427035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WV 3289) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NC 7706) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2007-07-08 |