| NPI | 1225226343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60144673) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D9072) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2026-04-01 |