| NPI | 1487643367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OR D9852) |
| Additional Taxonomies | 122300000X Dentist (Licence: HI DT-2174) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2016-02-02 |