| NPI | 1710049119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60103522) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MD 13879) |
| 1223E0200X Dentist, Endodontics (Licence: VA 0401411118) | |
| 1223E0200X Dentist, Endodontics (Licence: CA 47348) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2010-09-01 |