| NPI | 1942646302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 36688) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 057432) |
| 1223E0200X Dentist, Endodontics (Licence: VA 0401414890) | |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2021-12-08 |