| NPI | 1386692556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE00010481) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 46447) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2021-01-12 |