| NPI | 1891740023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: TX 26486) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: CO 9892) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2012-03-02 |