| NPI | 1265487433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 29635) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3215-02) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2014-09-04 |