| NPI | 1699098350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: NC 12078) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS024517L) |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2026-06-24 |