| NPI | 1740692490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 30805) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NC 9355) |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2022-03-30 |