| NPI | 1508267899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 7182-15) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TN 11454) |
| Enumeration Date | 2014-09-06 |
| Last Update Date | 2022-08-29 |