| NPI | 1770078313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: KY 10854) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10854) |
| 122300000X Dentist (Licence: NM DD4907) | |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2025-10-21 |