| NPI | 1497876684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 21622) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NE 6675) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2008-09-12 |