| NPI | 1699329854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 11448) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TN 13091) |
| Enumeration Date | 2019-07-26 |
| Last Update Date | 2026-08-11 |