| NPI | 1306256946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS040643) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 29782) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2022-07-21 |