| NPI | 1699960864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 58887) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NV 5560) |
| 1223E0200X Dentist, Endodontics (Licence: UT 6657777-9922) | |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2011-09-28 |