| NPI | 1316907868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 34794) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 5669246-9922) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2023-07-18 |