| NPI | 1568532364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: ID D-3954-EN) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 6470) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2007-07-09 |