| NPI | 1548414147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 57142) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS037696) |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2020-02-21 |