| NPI | 1275999492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MD 16820) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 1857095) |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2022-06-29 |