| NPI | 1235625047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: LA 7844) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MN D14085) |
| Enumeration Date | 2018-07-04 |
| Last Update Date | 2026-08-11 |