| NPI | 1871742643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CT 011196) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 57547) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2014-10-15 |