| NPI | 1972679405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SC SC3317) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: SC SC498) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2007-07-08 |