| NPI | 1235668054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NH 04832) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 11821) |
| 1223G0001X Dentist, General Practice (Licence: AZ D010271) | |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2023-10-26 |