| NPI | 1780178509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS042115) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: FL DRPM2041) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2024-11-12 |