| NPI | 1710195896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: SD M 750) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: SD M 750) |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2007-07-08 |