| NPI | 1538645445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MT 29899) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10080) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2025-07-16 |