| NPI | 1922330620 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA DDS34802)  | 
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: IN DL34802)  | 
| Enumeration Date | 2010-02-04 | 
| Last Update Date | 2025-03-03 |