| NPI | 1538471131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VA 0401413580) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: DC DEN1001127) |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2015-06-05 |