| NPI | 1295715522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: TX 22176) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 22176) |
| 1223P0700X Dentist Prosthodontics (Licence: TX 22176) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 22176) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TX 22176) | |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2024-12-03 |