| NPI | 1013980242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: CA 52190) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WA DE00004957) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2007-07-08 |