| NPI | 1356346407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WI 3285) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MN S65) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2013-07-25 |