| NPI | 1649241092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 55266) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 22375) |
| 1223E0200X Dentist, Endodontics (Licence: HI DT - 2276) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2014-09-12 |