| NPI | 1316341613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NV S7-118C) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 90437479922) |
| 122300000X Dentist (Licence: VA 0442000373) | |
| 1223E0200X Dentist Endodontics (Licence: TX 39171) | |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2025-05-13 |