| NPI | 1437590668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: UT 8710807) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 8710807-9921) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2017-03-09 |