| NPI | 1215297759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 26494) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WI 6806) |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2013-09-23 |