| NPI | 1487781878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: KY 5395) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 5395) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2015-01-20 |