| NPI | 1285185355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MO 2019008323) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D-4797) |
| 122300000X Dentist (Licence: MO 2019008323) | |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2022-09-28 |