| NPI | 1740369941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 21108) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2001001520) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2007-07-08 |