| NPI | 1881841252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 57731) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 10267) |
| 1223E0200X Dentist, Endodontics (Licence: TX 25288) | |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2014-03-27 |