| NPI | 1730476060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MS ENDO-491-14) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3603-11) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2014-12-02 |