| NPI | 1174721393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WV 3682) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MD 14908) |
| 1223E0200X Dentist, Endodontics (Licence: PA DS036617) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2022-10-05 |