| NPI | 1386701373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VA 0401416245) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 13352) |
| 1223E0200X Dentist, Endodontics (Licence: NY 055426) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2024-07-15 |