| NPI | 1104365881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 32231) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 32231) |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2024-06-09 |