| NPI | 1992054787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: WA DE60567455) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1856135) |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2016-11-09 |