| NPI | 1972881068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 62025) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038805) |
| Enumeration Date | 2011-07-24 |
| Last Update Date | 2020-10-26 |