| NPI | 1689749574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MA 19242) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NH 3244) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2007-10-17 |