| NPI | 1649451899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: HI 2334) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 8415) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2012-08-14 |