| 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 |