| NPI | 1003062977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 5385-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 5385) |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2022-10-17 |