| NPI | 1629206461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: IN 12012592) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WV 3855) |
| 1223E0200X Dentist, Endodontics (Licence: PA DS038280) | |
| 1223E0200X Dentist, Endodontics (Licence: SC 7140) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2018-02-20 |