| NPI | 1386950780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: PA DS038378) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038378) |
| Enumeration Date | 2010-08-23 |
| Last Update Date | 2023-07-21 |