| NPI | 1538114095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 25135) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: UT 5388076-9922) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2010-03-22 |