| NPI | 1225049943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OR D5536) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WA DE0006943) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2007-07-08 |