| NPI | 1619170271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: UT 5371953-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 5371953-9921) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2021-03-13 |