| NPI | 1649258401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist Endodontics (Licence: WA DE00010824) |
| Additional Taxonomies | 1223E0200X Dentist Endodontics (Licence: OR D7554) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2007-10-01 |