| NPI | 1558559609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 22684) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WA DE00009069) |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2009-12-30 |