| NPI | 1174524995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60350473) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 8407) |
| 1223G0001X Dentist, General Practice (Licence: TX 25944) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2022-10-26 |