| NPI | 1083960116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE-60603242) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: OR D9752) |
| 122300000X Dentist (Licence: WA DE60603242) | |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2023-05-10 |