| NPI | 1265861546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60576809) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039620) |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2015-09-01 |