| NPI | 1710532221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60981345) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60981345) |
| Enumeration Date | 2019-08-02 |
| Last Update Date | 2020-08-18 |