| NPI | 1548254345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: UT 5348402-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 5348402-9922) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2008-08-25 |