| NPI | 1538130752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO 10046) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: ID D-3585) |
| 1223E0200X Dentist, Endodontics (Licence: FL DN18177) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2010-06-27 |