| NPI | 1558610584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60308272) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OR D10723) |
| 122300000X Dentist (Licence: WA DE60308272) | |
| 122300000X Dentist (Licence: OR D10723) | |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2026-03-06 |