| NPI | 1790855542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE00009070) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00009070) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2023-10-10 |