| NPI | 1396961157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: ID D4267) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 46364) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2009-11-09 |