| NPI | 1659492155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 6603) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA 04-250820) |
| 1223G0001X Dentist, General Practice (Licence: KY 7675) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2007-07-08 |