| NPI | 1073864963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60944562) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 8418211-9921) |
| 1223E0200X Dentist, Endodontics (Licence: OR D11375) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: UT 8418211-9921) | |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2021-05-10 |