| NPI | 1205057585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: MS 2403) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: MS ENDO22092) |
| 1223E0200X Dentist Endodontics (Licence: TN DS0000005162) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2007-07-08 |