| NPI | 1063590503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ Do11576) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D8309) |
| 1223G0001X Dentist, General Practice (Licence: WA DE00009679) | |
| 1223G0001X Dentist, General Practice (Licence: AK AK1116) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2022-10-12 |