| NPI | 1164417267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 23777) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901019436) |
| 1223G0001X Dentist, General Practice (Licence: NJ 22DI02264400) | |
| 1223G0001X Dentist, General Practice (Licence: PA DS035851) | |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2009-05-04 |