| NPI | 1316959513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: ME 4291) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: UT 6218732) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2017-11-07 |