| NPI | 1588198386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA DDS108122) |
| Additional Taxonomies | 122300000X Dentist (Licence: NH 04514) |
| 122300000X Dentist (Licence: MA DN1857830) | |
| 1223E0200X Dentist, Endodontics (Licence: TX 33452) | |
| 1223G0001X Dentist, General Practice (Licence: PA DS041456) | |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2023-03-24 |