| NPI | 1164927059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: MD 18119) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS042830) |
| Enumeration Date | 2018-03-24 |
| Last Update Date | 2023-08-30 |