| NPI | 1487937371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: PA DS038716) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: CA 62611) |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2015-01-27 |