| NPI | 1609121599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: TX 32233) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: FL 1087) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2019-05-06 |