| NPI | 1003337536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D009740) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D009740) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2022-03-02 |