| NPI | 1972617769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TX 29857) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: KS 60417) |
| 122300000X Dentist (Licence: KS 60417) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2018-07-26 |