| NPI | 1881608784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 52700) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 000032) |
| 1223G0001X Dentist, General Practice (Licence: AZ 6120) | |
| 1223G0001X Dentist, General Practice (Licence: CT 009797) | |
| 1223E0200X Dentist, Endodontics (Licence: CT 009797) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2013-03-04 |