| NPI | 1134190515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 15921) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: FL DN12164) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2023-04-11 |