| NPI | 1457380644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60994995) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN17560) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2022-07-29 |