| NPI | 1235323528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 23469) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 56200) |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2010-12-29 |