| NPI | 1780946558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS041361) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 122300000) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2017-06-20 |