| NPI | 1912118118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: FL DN17852) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: CA 55473) |
| 1223E0200X Dentist Endodontics (Licence: AZ D6709) | |
| Enumeration Date | 2007-05-28 |
| Last Update Date | 2009-05-14 |