| NPI | 1750778072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: UT 11897186-9922) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: AZ 9177) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2021-05-24 |