| NPI | 1194487959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE61537989) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D11549) |
| Enumeration Date | 2021-10-08 |
| Last Update Date | 2024-07-28 |