| NPI | 1316209216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60467462) |
| Additional Taxonomies | 122300000X Dentist (Licence: ME DEN4245) |
| 122300000X Dentist (Licence: OR D10557) | |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2020-11-17 |