| NPI | 1457339194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VA 0401416041) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 6545) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2020-07-30 |