| NPI | 1043466378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: WA DE61453479) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: TN 12207) |
| 1223E0200X Dentist Endodontics (Licence: GA DN014100) | |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2023-08-31 |