| NPI | 1124160874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: MT 9614) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: PA DS037031) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2019-01-16 |