| NPI | 1144476813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: WA DE60717233) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: TX 25099) |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2022-07-21 |