| NPI | 1184792160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: MS 3373-06) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 5885) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2014-07-13 |