| NPI | 1245356245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AK 1189) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR 8665) |
| 122300000X Dentist (Licence: WA DE00011127) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2017-03-07 |