| NPI | 1609182203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 58140) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS038066) |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2011-11-11 |