| NPI | 1790897569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: CO 6835) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: CA 44742) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-09-19 |