| NPI | 1710028204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: LA 6295) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MS 3669-12) |
| 1223E0200X Dentist, Endodontics (Licence: TN 7122) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2012-07-18 |