| NPI | 1225436322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60868940) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: HI DT 2567) |
| Enumeration Date | 2014-12-05 |
| Last Update Date | 2019-10-03 |