| NPI | 1326148636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 19218) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 19218tt) |
| 1223G0001X Dentist, General Practice (Licence: TX 19218) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2019-11-22 |