| NPI | 1871705442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 8594) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: SC 3921) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2011-09-23 |