| NPI | 1710020045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SD D0923) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NC 8331) |
| 1223E0200X Dentist, Endodontics (Licence: AZ D4704) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2014-07-21 |