| NPI | 1659607653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MN D12910) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MA DN1855145) |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2011-06-05 |