| NPI | 1407297484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 62475) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TN 11869) |
| 122300000X Dentist (Licence: CO DEN.00203425) | |
| 1223G0001X Dentist, General Practice (Licence: TX 31790) | |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2026-07-08 |