| NPI | 1346688520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 9094625-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE 60384641) |
| 1223G0001X Dentist, General Practice (Licence: ID D4540) | |
| Enumeration Date | 2013-06-10 |
| Last Update Date | 2014-09-09 |