| NPI | 1073698544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 19915) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: HI DT-2054) |
| 1223G0001X Dentist, General Practice (Licence: HI DT-2054) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2022-05-12 |