| NPI | 1427210780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D011535) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: WA PA60034324) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2022-08-02 |