| NPI | 1316251242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60086218) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 59939) |
| 1223X2210X Dentist, Orofacial Pain (Licence: CA 59939) | |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2024-02-07 |