| NPI | 1205314515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AL ST-000369) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60788846) |
| 174H00000X Health Educator | |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2023-03-04 |