| NPI | 1669039244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS042149) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS042149) |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2022-09-06 |