| NPI | 1891220596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 32866) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 4039) |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2021-01-07 |