| NPI | 1386166742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60768332) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OR D10668) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2026-05-25 |