| NPI | 1518273119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 38801) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO DEN.00202019) |
| 122300000X Dentist (Licence: UT 7706435-9922) | |
| 1223G0001X Dentist, General Practice (Licence: UT 7706435-9922) | |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2022-07-22 |