| NPI | 1982647558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 21733) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 21733) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2010-06-22 |