| NPI | 1376927053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60687419) |
| Additional Taxonomies | 122300000X Dentist (Licence: HI DT 2605) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2020-03-19 |