| NPI | 1194707554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: TX 39329) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: HI DT-2049) |
| 1223G0001X Dentist General Practice (Licence: HI 2049) | |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2023-10-10 |