| NPI | 1417306820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: TN 11210) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021895) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2023-07-04 |