| NPI | 1255342499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: VA 0401410127) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: FL DN 14843) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-07-08 |