| NPI | 1184128688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D011390) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ D011390) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2022-10-02 |