| NPI | 1245716950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60793018) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 102623) |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2025-05-03 |