| NPI | 1689836439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: KY 9102) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12011193A) |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2011-10-14 |