| NPI | 1154983690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SC 10299) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12013232A) |
| Enumeration Date | 2019-07-04 |
| Last Update Date | 2022-10-28 |