| NPI | 1235572033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WV 4092) |
| Additional Taxonomies | 122300000X Dentist (Licence: WV 4092) |
| 1223E0200X Dentist, Endodontics (Licence: PA DS041545) | |
| 1223E0200X Dentist, Endodontics (Licence: MD 16621) | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2022-07-01 |