| NPI | 1497005698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 30672) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX ETN42) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2015-02-05 |