| NPI | 1548245764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 31828) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: SC 3098) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2017-04-27 |