NPI | 1558610584 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60308272) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE60308272) |
122300000X Dentist (Licence: OR D10723) | |
1223E0200X Dentist, Endodontics (Licence: OR D10723) | |
Enumeration Date | 2012-09-06 |
Last Update Date | 2023-01-16 |