| NPI | 1437560810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE00009485) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00009485) |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2018-09-07 |