| NPI | 1083962120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60299028) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60299028) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2012-08-21 |