| NPI | 1083605711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MS 3893-16) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D3731) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2022-12-28 |