| 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 |