| NPI | 1962901322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: FL DN25211) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS042962) |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2022-01-08 |