| NPI | 1134434475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60233845) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: PA DS038054) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2022-07-21 |