| NPI | 1578811758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA DN122928) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: KS 61690) |
| 1223G0001X Dentist, General Practice (Licence: TX 28236) | |
| 1223E0200X Dentist, Endodontics (Licence: TX 28236) | |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2022-11-21 |