| NPI | 1770716243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 25904) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 58700) |
| 1223G0001X Dentist, General Practice (Licence: TX 25904) | |
| Enumeration Date | 2009-08-31 |
| Last Update Date | 2013-12-13 |