| NPI | 1063834505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TN 10704) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 7176-15) |
| 1223E0200X Dentist, Endodontics (Licence: NC 9954) | |
| 1223E0200X Dentist, Endodontics (Licence: WA DE 60730973) | |
| Enumeration Date | 2014-01-17 |
| Last Update Date | 2023-07-12 |