| NPI | 1508051889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MD 18922) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: DC DEN5982) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2026-09-14 |