| NPI | 1972761765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: UT 7025150-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 7025150-9921) |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2023-11-01 |