| NPI | 1205172095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VA 0401415099) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MD 15635) |
| 1223E0200X Dentist, Endodontics (Licence: DC CS1600023) | |
| Enumeration Date | 2012-12-24 |
| Last Update Date | 2016-05-18 |