| NPI | 1982739371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NH 03505) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: MA 19806) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2022-03-28 |