| NPI | 1275927758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D-5484) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60555291) |
| 122300000X Dentist (Licence: WA DE60555291) | |
| 1223G0001X Dentist, General Practice (Licence: WA RR60441835) | |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2024-07-01 |