| NPI | 1811474661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: UT 10910384-9924) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 10910384-9921) |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2025-07-10 |