| NPI | 1285838391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NM DD3195) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: AZ D7327) |
| 1223G0001X Dentist, General Practice (Licence: PA DS037026) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2012-03-28 |