| NPI | 1962482323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: VA 0401411234) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS030278L) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2007-07-08 |