| NPI | 1902919244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 29547) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN 17746) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2016-07-08 |