| NPI | 1023078284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: TX 22706) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: UT 4789791-9921) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2007-07-08 |