| NPI | 1780065060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 31660) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6698) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2022-10-18 |