| NPI | 1912127895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 41317) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NV S7-64) |
| 1223E0200X Dentist, Endodontics (Licence: AZ 8884) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2025-05-12 |