| NPI | 1639245111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: OR D11941) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 4220-21) |
| 1223E0200X Dentist Endodontics (Licence: FL 466) | |
| 1223E0200X Dentist Endodontics (Licence: MS ENDO-600-21) | |
| 1223E0200X Dentist Endodontics (Licence: TN TN9076) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2024-08-12 |