| NPI | 1265885180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 35011) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 35011) |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2022-12-09 |