| NPI | 1992765820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 29799) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: AZ 7974) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2014-04-14 |