| NPI | 1760035422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 12694) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D-5064) |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2022-07-18 |