| NPI | 1316341613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NV s7-118c) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 39171) |
| 122300000X Dentist (Licence: UT 90437479922) | |
| 122300000X Dentist (Licence: VA 0442000373) | |
| Enumeration Date | 2014-10-15 |
| Last Update Date | 2023-10-23 |