| NPI | 1962580472 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MN D10716) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NM DD2828) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2019-05-23 |