| NPI | 1689875395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NV S7-132C) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: TX 38081) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2023-05-09 |