| NPI | 1235703018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SC 11236) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC DGD.10758) |
| 122300000X Dentist (Licence: LA 7213) | |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2025-10-18 |