| NPI | 1235416405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60277312) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D-4385) |
| 1223G0001X Dentist, General Practice (Licence: AZ D009794) | |
| 122300000X Dentist (Licence: WA DE 60277312) | |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2023-07-07 |