| NPI | 1255712675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS043394) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2015017915) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2023-06-29 |