| NPI | 1407831886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 18433) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: AZ 6016) |
| 1223E0200X Dentist, Endodontics (Licence: CA 30081) | |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2009-05-04 |