| NPI | 1255313680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OK 45) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 5745) |
| 1223E0200X Dentist, Endodontics (Licence: UT 9074817) | |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2014-09-17 |