| NPI | 1215716840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401418654) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: VA 0401418654) |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2024-09-16 |