| NPI | 1114295771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS041823) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401413810) |
| 1223E0200X Dentist, Endodontics (Licence: NY 057629) | |
| 1223E0200X Dentist, Endodontics (Licence: NJ 22DI02611500) | |
| 1223E0200X Dentist, Endodontics (Licence: FL DN19663) | |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2023-10-23 |