| NPI | 1639564784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VA 0401418531) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WI 1001094-15) |
| Enumeration Date | 2015-04-04 |
| Last Update Date | 2024-09-20 |