| NPI | 1942600127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE 60474896) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: TX 30424) |
| Enumeration Date | 2014-08-25 |
| Last Update Date | 2021-04-05 |