| NPI | 1295997807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 26390) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NC 9009) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2015-06-09 |