| NPI | 1427210780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D011535) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60034324) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2025-09-18 |