| NPI | 1124387683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 35703) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 81236609921) |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2022-02-15 |