| NPI | 1801866819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NV s7-63) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 21098) |
| 1223G0001X Dentist, General Practice (Licence: CA 55598) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2010-12-20 |