| NPI | 1710292040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: TX 38394) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 7718094-9921) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2023-04-10 |