| NPI | 1003941170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: OR D11009) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: WA DE60502349) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2021-05-19 |