| NPI | 1942437025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 25600) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 14284) |
| 122300000X Dentist (Licence: CA 55393) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2024-07-29 |