| NPI | 1205801925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 5820-015) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 8470) |
| 1223E0200X Dentist, Endodontics (Licence: IL 021002433) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2014-10-23 |