| NPI | 1114017274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NV S7-125) |
| Additional Taxonomies | 122300000X Dentist (Licence: HI DT2060) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2022-02-06 |