| NPI | 1598335689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WV 4515) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS044547) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2024-08-05 |