| NPI | 1437649225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61514497) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D010391) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2024-04-12 |