| NPI | 1780892208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS036886) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS036886) |
| 122300000X Dentist (Licence: CA 54635) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2021-07-24 |