| NPI | 1386858587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA 7248) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 37293) |
| 1223E0200X Dentist, Endodontics (Licence: ID D3042) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2007-07-08 |