| NPI | 1568504140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN 19111) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019441) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2011-08-18 |