| NPI | 1104356450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PR 3490) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MA DN1857981) |
| 1223E0200X Dentist, Endodontics (Licence: CT 13547) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2024-07-22 |