| NPI | 1487087516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60792883) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D10325) |
| 1223E0200X Dentist, Endodontics (Licence: OR D10325) | |
| 122300000X Dentist (Licence: UT 8749417-9921) | |
| 1223E0200X Dentist, Endodontics (Licence: UT 8749417-9921) | |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2024-03-13 |