| NPI | 1326369133 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO 10202) | 
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS044153) | 
| Enumeration Date | 2010-06-15 | 
| Last Update Date | 2025-07-09 |