| NPI | 1427360015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IA 4099) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: IA 4099) |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2010-07-12 |