| NPI | 1205926110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D9236) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00008175) |
| 1223G0001X Dentist, General Practice (Licence: CO DEN00201961) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2023-06-20 |