| NPI | 1063484525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OR D10954) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NY 058366) |
| 1223E0200X Dentist, Endodontics (Licence: PA DS030484L) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2019-01-03 |