| NPI | 1467060103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS044335) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 36355) |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2025-01-10 |