| NPI | 1265505408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: OR D7505) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: HI 1571) |
| 1223E0200X Dentist Endodontics (Licence: CA 35662) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2016-08-03 |