| NPI | 1326291295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MT 1821) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 22554) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2019-02-27 |