| NPI | 1164737953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 4710) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: GA Dn015954) |
| Enumeration Date | 2010-08-17 |
| Last Update Date | 2026-04-13 |