| NPI | 1679551626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60445830) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D-3633) |
| 1223E0200X Dentist, Endodontics (Licence: ID D-3633) | |
| 1223E0200X Dentist, Endodontics (Licence: CO DEN.00010388) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2014-05-22 |