| NPI | 1508398272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VT 016.0133883) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1857904) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2020-07-27 |