| NPI | 1497801674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SC 0649) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WV 3645/26) |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2012-07-12 |