| NPI | 1821558966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MD 17041) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 17041) |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2025-08-01 |