| NPI | 1982614962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: LA 5126) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 22262) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2020-03-30 |