| NPI | 1053719427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 11774) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE000010020) |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2022-09-21 |