| NPI | 1003895939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: WA DE00010489) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00010489) |
| 122300000X Dentist (Licence: WA DN 10489) | |
| 122300000X Dentist (Licence: NC 9078) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2022-08-08 |