| NPI | 1396987079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NC 3871) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 3871) |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2011-10-07 |