| NPI | 1285613562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 8731) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: SC sc 3083) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2010-04-21 |