| NPI | 1881695674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO 7151) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 52141) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2007-07-08 |