| NPI | 1316295231 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN20068) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS039292) |
| 1223G0001X Dentist, General Practice (Licence: TX 28414) | |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2022-07-21 |