| NPI | 1033425863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: UT 7725537-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 7725537-9921) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2018-06-12 |