| NPI | 1689796856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 58227) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MA 21797) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2009-06-16 |