| NPI | 1720052970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 25112) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: AZ D6670) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2012-12-19 |