| NPI | 1114174018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 23420) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS037448) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2010-04-30 |