| NPI | 1922261908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WV 3815) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MD 15197) |
| 1223E0200X Dentist, Endodontics (Licence: PA DS037625) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2022-10-17 |