| NPI | 1447573233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DR 60389407) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK 1439) |
| 1223G0001X Dentist, General Practice (Licence: ID D4268) | |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2013-07-23 |