| NPI | 1710109996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TN 8491) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 3215) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-08-19 |