| NPI | 1255496972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE8575) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: ID N-04265) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2016-09-19 |