| NPI | 1396973418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60996227) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 24705) |
| Enumeration Date | 2009-06-26 |
| Last Update Date | 2019-11-25 |