| NPI | 1265420194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE00011088) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD1803) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2023-11-14 |