| NPI | 1831525393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 29338) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 29338) |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2024-03-18 |