| NPI | 1912046475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 28753) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: ND 1848) |
| 1223E0200X Dentist, Endodontics (Licence: MN D10806) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2014-06-16 |