| NPI | 1477641025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: AZ D010627) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WA DE00010234) |
| 1223E0200X Dentist, Endodontics (Licence: OR D9863) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-05-21 |