| NPI | 1689725749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: SC 0446) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: VA 0401007319) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2007-07-08 |