| NPI | 1295176212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D010646) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62472) |
| 1223E0200X Dentist, Endodontics (Licence: TX 31520) | |
| 1223E0200X Dentist, Endodontics (Licence: CA 62472) | |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2021-12-26 |