| NPI | 1174790539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: RI 3032) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MA 20728) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2010-01-12 |