| NPI | 1063629434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 47407) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 36811) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2024-04-30 |