| NPI | 1548325236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 3647) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: SC 616) |
| Enumeration Date | 2006-12-24 |
| Last Update Date | 2007-07-08 |