| NPI | 1265421168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN28896) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS036172) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2025-01-31 |