| NPI | 1861690034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: NC 9945) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: PA DS036580) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2015-02-27 |