| NPI | 1861687261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA DS037158) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA ds037158) |
| Enumeration Date | 2007-09-09 |
| Last Update Date | 2020-01-16 |