| NPI | 1295902849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: CT 4956) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 4956DENTIST) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2015-01-07 |