| NPI | 1275093247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 14186) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 39) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2026-01-15 |