| NPI | 1528296399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60720894) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D4237) |
| 122300000X Dentist (Licence: WA DE60720894) | |
| 1223E0200X Dentist, Endodontics (Licence: WA 60720894) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2022-08-04 |