| NPI | 1992298137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VA 0401416379) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401416379) |
| 1223G0001X Dentist, General Practice (Licence: AZ 10015) | |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2024-08-19 |