| NPI | 1720169394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60163079) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 54645) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2010-08-19 |