NPI | 1336436906 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60739379) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE60739379) |
Enumeration Date | 2011-07-05 |
Last Update Date | 2025-04-03 |