| NPI | 1538510698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: TX 32852) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223G0001X Dentist General Practice (Licence: TX 32852) | |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2021-08-24 |