| NPI | 1558776260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MD 15514) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: VA 0401414479) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2019-01-11 |