| NPI | 1780890608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO 10040) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 019.027172) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2010-12-22 |