| NPI | 1275503773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SC 0349) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 2765) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2016-06-14 |