| NPI | 1598801037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VA 0401411746) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 19191) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2009-08-21 |