| NPI | 1558526368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: OR D9588) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WA DE 60152137) |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2016-08-03 |