| NPI | 1700010709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MD 14405) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 56602) |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2009-05-06 |