| NPI | 1750455960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 27981) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: AZ D7048) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2012-08-11 |