| NPI | 1356070536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 40968) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 40968) |
| Enumeration Date | 2022-06-06 |
| Last Update Date | 2024-09-24 |