| NPI | 1710247366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OH 30.026035) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039476) |
| 1223E0200X Dentist, Endodontics (Licence: PA DS039476) | |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2021-10-11 |