| NPI | 1376717322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CO 9651) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS030834L) |
| Enumeration Date | 2008-04-21 |
| Last Update Date | 2014-07-31 |