| NPI | 1992962070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401008063) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MD 9122) |
| Enumeration Date | 2008-05-17 |
| Last Update Date | 2008-05-17 |