| NPI | 1134171010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VA 0401410767) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 401410767) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2014-09-23 |