| NPI | 1841272390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: TX 21548) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 21584) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2009-09-28 |