| NPI | 1982008959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: PA DS041524) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: VA 0401414600) |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2022-12-19 |