| NPI | 1487752994 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS036707) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 21167) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2024-04-18 |