| NPI | 1386962629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D008809) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 28873) |
| 1223E0200X Dentist, Endodontics (Licence: AK 105009) | |
| 122300000X Dentist (Licence: KY 8913) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2026-02-06 |