| NPI | 1447361381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID 820508017) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D10222) |
| 122300000X Dentist (Licence: WA DE60553642) | |
| 122300000X Dentist (Licence: ID D1427) | |
| 122300000X Dentist (Licence: CA 64339) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-06-02 |