| NPI | 1457642043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NE 7490) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MA DN1856704) |
| 1223E0200X Dentist, Endodontics (Licence: NY 063074) | |
| 1223E0200X Dentist, Endodontics (Licence: KS 61975) | |
| Enumeration Date | 2011-04-29 |
| Last Update Date | 2025-07-27 |