| NPI | 1457363707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60918629) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA CA25712) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2020-12-15 |