| NPI | 1578781001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IN 12011293A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.027205) |
| 122300000X Dentist (Licence: KY 8501) | |
| Enumeration Date | 2007-04-22 |
| Last Update Date | 2011-12-30 |