| NPI | 1831714740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MD 17724) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 17724) |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2024-07-02 |