| NPI | 1649392382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO DEN000000005149) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MN D9660) |
| 1223E0200X Dentist, Endodontics (Licence: WY 899) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2007-07-08 |