| NPI | 1154554442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA DN016141) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 28682) |
| 122300000X Dentist (Licence: TN 9026) | |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2021-02-06 |