| NPI | 1407914385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA 09621) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 7505) |
| 1223G0001X Dentist, General Practice (Licence: AZ 4862) | |
| 1223G0001X Dentist, General Practice (Licence: WI 1002237) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2021-08-27 |