| NPI | 1477596625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: UT 5368303-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 5368603-9921) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2023-06-26 |