| NPI | 1952955981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE61300960) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: MA Applied) |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2022-12-01 |