| NPI | 1558610139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: DE G1-0011475) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS042144) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2023-06-19 |