| NPI | 1831294032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D7377) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 050281) |
| 1223E0200X Dentist, Endodontics (Licence: PA DS036316) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2010-08-24 |