| NPI | 1922235639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: UT 7999868-9922) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: KY 8787) |
| Enumeration Date | 2009-06-20 |
| Last Update Date | 2011-08-01 |