| NPI | 1760630586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 25422) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TN 8673) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2011-03-01 |