| NPI | 1427318427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 60569432) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 9185) |
| 122300000X Dentist (Licence: UT 8303527-9923) | |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2016-11-12 |