| NPI | 1912949595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IA 08284) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 08284) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2009-11-09 |