| NPI | 1184735847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS030789L) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS030789L) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-05-14 |