| NPI | 1588635072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WI 6495-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 4278) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901018211) | |
| 122300000X Dentist (Licence: IL 019028225) | |
| 122300000X Dentist (Licence: CA 49796) | |
| 1223E0200X Dentist, Endodontics (Licence: VA 0401414365) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2014-10-18 |