| NPI | 1639163892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO 9170) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 48507) |
| 1223E0200X Dentist, Endodontics (Licence: KY 7262) | |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2007-07-08 |