| NPI | 1699737833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WI 4132) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WA DE7421) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2012-07-30 |