| NPI | 1649809583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11523) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OR D11523) |
| 1223G0001X Dentist, General Practice (Licence: OR D11523) | |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2026-03-25 |