| NPI | 1154525939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS 037976) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: NV S7-70c) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2010-05-12 |