| NPI | 1043620701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS042240) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223E0200X Dentist, Endodontics (Licence: MD 16691) | |
| Enumeration Date | 2014-05-04 |
| Last Update Date | 2019-12-10 |