| NPI | 1760618110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IA 08617) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6543) |
| 122300000X Dentist (Licence: WY 1127) | |
| Enumeration Date | 2009-05-29 |
| Last Update Date | 2009-05-29 |