| NPI | 1982916508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60166205) |
| Additional Taxonomies | 1223E0200X Dentist, Endodontics (Licence: CA 101281) |
| 1223G0001X Dentist, General Practice (Licence: WA DE60166205) | |
| Enumeration Date | 2010-07-12 |
| Last Update Date | 2021-03-01 |