| NPI | 1821464421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: KS 61762) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 9444507-9921) |
| Enumeration Date | 2015-08-18 |
| Last Update Date | 2022-03-07 |