| NPI | 1699969162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AK 1245) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WI 7112-15) |
| 1223E0200X Dentist, Endodontics (Licence: CO DEN.00201864) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2013-07-16 |