| NPI | 1437362142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR 3900) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OR 3900) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2012-05-14 |