| NPI | 1427015080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TN 8219) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 053483) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2020-09-14 |