| NPI | 1528038650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MD 08815) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 18434) |
| 1223E0200X Dentist, Endodontics (Licence: NC 9828) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2023-03-07 |