| NPI | 1497725162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ 7744) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 4943072-9921) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2015-02-04 |