| NPI | 1649228206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 21926) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 21926) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2014-07-10 |