| NPI | 1952513616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 25989) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS038491) |
| 1223E0200X Dentist, Endodontics (Licence: NY 051276-1) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-11-06 |