| NPI | 1063465748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 25756) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN-8796) |
| 122300000X Dentist (Licence: KY 8595) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2015-11-07 |