| NPI | 1861549990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VA 0401008477) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: SC 10786) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2026-01-23 |