| NPI | 1790851269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 5880) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 5880) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2014-09-10 |