| NPI | 1043426943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: TX 29523) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: AZ D7207) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2021-01-15 |