| NPI | 1326599101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60807591) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 6837) |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2018-05-09 |