| NPI | 1942239017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WY 1225) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D8614) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2013-01-04 |