| NPI | 1730735770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 35090) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 35090) |
| 122300000X Dentist (Licence: NE 7892) | |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2025-07-09 |