| NPI | 1033526595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60557702) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV LL-374-14) |
| 1223G0001X Dentist, General Practice (Licence: WA de60557702) | |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2023-01-05 |