| NPI | 1215243746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS038311) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038311) |
| Enumeration Date | 2010-08-21 |
| Last Update Date | 2019-01-15 |