| NPI | 1366992471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 105783) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 32482) |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2020-11-03 |