| NPI | 1295141091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: MD 15787) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: PA DS039943) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2022-01-09 |