| NPI | 1467999102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN24702) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 32640) |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2026-04-08 |