| NPI | 1831754795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: TN 12449) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.032265) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2024-05-20 |