| NPI | 1770165862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MN D14662) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NE 7988) |
| 1223E0200X Dentist, Endodontics (Licence: IA DDS-09911) | |
| Enumeration Date | 2021-04-27 |
| Last Update Date | 2026-07-13 |