| NPI | 1427119544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS036597) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NJ 22DI02297000) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2017-11-08 |