| NPI | 1437342656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 62225) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 6668447-9922) |
| 1223E0200X Dentist, Endodontics (Licence: LA 6057) | |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2013-08-27 |