| NPI | 1669760823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 27220) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 27220) |
| 1223E0200X Dentist, Endodontics (Licence: NC 10509) | |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2019-07-15 |