| NPI | 1326369133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS044153) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 10202) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2023-07-19 |