| NPI | 1124509468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA 60857316) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 60857316) |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2018-08-24 |