| NPI | 1558591511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 24492) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MO 2007016328) |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2020-06-30 |