| NPI | 1962600437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: SC 4425) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: HI DT2414) |
| 1223E0200X Dentist, Endodontics (Licence: MI 2901019802) | |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2011-10-21 |