| NPI | 1164651907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 19970) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TN 8998) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2009-12-16 |