| NPI | 1437483609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IA 40120) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 24761) |
| Enumeration Date | 2009-09-21 |
| Last Update Date | 2011-09-07 |