| NPI | 1063605806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NV 5754) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 22219) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2007-08-24 |