| NPI | 1083846927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60102400) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D-4246) |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2021-08-17 |