| NPI | 1952497711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 5622) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: LA 3995) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2007-07-08 |