| NPI | 1669473120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN17887) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: SC 4098) |
| 1223E0200X Dentist, Endodontics (Licence: PA DS030989L) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2007-07-17 |