| NPI | 1396935474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AK 1375) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60091370) |
| 122300000X Dentist (Licence: MN D12468) | |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2011-06-24 |