| NPI | 1609855774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: UT 4940888-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 4940888-9922) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2022-11-21 |