| NPI | 1831286178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60041564) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WA DF0000090) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2019-06-20 |