| NPI | 1407298052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VA 0401414021) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414021) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2025-05-26 |