| NPI | 1598852188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MT 4131) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OR D9248) |
| 1223G0001X Dentist, General Practice (Licence: TX 22555) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2019-02-27 |