| NPI | 1083055867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60884749) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: MN D13069) |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2021-03-22 |