| NPI | 1780720482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: MI 2901022629) |
| Additional Taxonomies | 122300000X Dentist (Licence: HI DT2286) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2018-06-19 |