| NPI | 1649492224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 24429) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D11797) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2010-03-29 |