| NPI | 1366578262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 23329) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 23138) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2010-10-05 |