| NPI | 1114901261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 31409) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 31409) |
| 122300000X Dentist (Licence: ID D-3906) | |
| 1223E0200X Dentist, Endodontics (Licence: ID D-3906) | |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2023-10-16 |