| NPI | 1700089984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VA 0401412778) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 54531) |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2011-06-10 |