| NPI | 1407586274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SC 10938) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC DGD.10222) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2024-09-03 |