| NPI | 1508010026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VA 0401412083) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401412083) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2012-07-04 |