| NPI | 1255712055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: UT 13065309-9923) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: AZ D009841) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2023-07-18 |