| NPI | 1104168020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NE 7963) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS039594) |
| Enumeration Date | 2013-03-18 |
| Last Update Date | 2023-09-12 |