| NPI | 1841553609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OR D10144) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: OH RES3200) |
| 1223E0200X Dentist, Endodontics (Licence: WA DE61143049) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2022-05-25 |