| NPI | 1427029503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: OR D9544) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: WA 9471) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2011-01-06 |