| NPI | 1255328068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WI 5880-015) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 5880-015) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2020-08-10 |