| NPI | 1245758846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D010860) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D010860) |
| Enumeration Date | 2017-09-03 |
| Last Update Date | 2022-07-21 |