| NPI | 1114112794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 23232) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 03812) |
| Enumeration Date | 2007-09-07 |
| Last Update Date | 2024-03-11 |