| NPI | 1902101827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 27848) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS038560) |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2012-07-10 |