| NPI | 1134190796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401008120) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: FL DN 10257) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2013-04-22 |