| NPI | 1922179217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: OR D8724) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: WA DE60215887) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2011-05-19 |