| NPI | 1699813550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 38361) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 52380) |
| 1223E0200X Dentist, Endodontics (Licence: CA 52380) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2026-10-14 |