| NPI | 1760635841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60041803) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60041803) |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2014-03-19 |