| NPI | 1285919936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 7279) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60242043) |
| 1223G0001X Dentist, General Practice (Licence: MO 2012012890) | |
| Enumeration Date | 2011-10-13 |
| Last Update Date | 2016-01-29 |