| NPI | 1356638597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D9575) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 59948) |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2016-12-13 |