| NPI | 1902028467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MS 3143-00) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: VA 0401411945) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2010-08-04 |