| NPI | 1811070501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE00007018) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 7018) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2019-03-15 |