| NPI | 1689895815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WV 3456) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS031277L) |
| 1223E0200X Dentist, Endodontics (Licence: MD 14910) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2023-10-26 |