| NPI | 1073094199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE61364441) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL13763) |
| 1223E0200X Dentist, Endodontics (Licence: TX 36869) | |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2022-12-15 |