| NPI | 1821098807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OR D10778) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: AK 119150) |
| 1223E0200X Dentist, Endodontics (Licence: SD D0906) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2018-03-29 |