| NPI | 1255611596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN21752) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DSO38862) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2019-07-31 |