| NPI | 1205070497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 40259) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 055392-1) |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2024-05-21 |