| NPI | 1053444026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D10004) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60267784) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2015-06-03 |