| NPI | 1962450130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 60869) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS027034L) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2019-07-20 |