| NPI | 1154499226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D6268) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE8114) |
| 122300000X Dentist (Licence: ID D-3372) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2022-07-21 |