| NPI | 1356558852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: ID D-5078-EN) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 46454) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2022-07-07 |