| NPI | 1285617555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: IA 07448) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IA 07448) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2009-07-29 |