| NPI | 1578069167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ 10577) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: KY 10342) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2026-05-06 |