| NPI | 1518027093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: UT 3115839921) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: UT 3115839921) |
| 1223P0300X Dentist, Periodontics (Licence: WY 1022) | |
| 1223E0200X Dentist, Endodontics (Licence: WY 1022) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2008-02-28 |