| NPI | 1427505056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SD D1300) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: IA RES-30483) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2021-12-08 |