| NPI | 1154844298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11731) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 101609) |
| 122300000X Dentist (Licence: WA DE61450268) | |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2024-07-12 |