| NPI | 1235224940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA 9916) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 51333) |
| 1223G0001X Dentist General Practice (Licence: AZ D5892) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2023-08-29 |