| NPI | 1730525809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TN 10482) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 057594) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2021-07-16 |