| NPI | 1851752166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 37192) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 37192) |
| 1223E0200X Dentist, Endodontics (Licence: CO 00202762) | |
| 1223G0001X Dentist, General Practice (Licence: CO 00202762) | |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2021-10-25 |