| NPI | 1932210531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: AL 3661) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: GA 9500) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2011-03-08 |