| NPI | 1962076539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401417346) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS044851) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2024-12-10 |