| NPI | 1184971483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AK 212245) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 61644) |
| 1223G0001X Dentist, General Practice (Licence: WA 60489982) | |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2024-04-22 |