| NPI | 1972912301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 8389) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: SC 8389) |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2024-09-18 |