| NPI | 1508304866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 41400) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NC 10944) |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2025-09-09 |