| NPI | 1447663083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: UT 9058059-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 9058059-9922) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2021-08-18 |