| NPI | 1245672625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA DDS110030) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039704) |
| 1223E0200X Dentist, Endodontics (Licence: TX 40142) | |
| 1223E0200X Dentist, Endodontics (Licence: PA DS039704) | |
| Enumeration Date | 2013-07-25 |
| Last Update Date | 2024-08-07 |