| NPI | 1679898001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: OR 5456 OREGON) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: OR 5456) |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2010-03-29 |