| NPI | 1871840876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TN 11204) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.029130) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2020-02-17 |