| NPI | 1912289570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: PA RFD000052) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 27460) |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2023-02-01 |