| NPI | 1659809242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 32890) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS041198) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2021-01-19 |