| NPI | 1841714672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID LEO CLOUTIER Manager Member 210-341-8281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 26412) |
| Enumeration Date | 2017-08-02 |
| Last Update Date | 2019-06-12 |