| NPI | 1508172107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 7754866-9921) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 7754866-9921) |
| 122300000X Dentist (Licence: WA DE60162914) | |
| 1223D0001X Dentist, Dental Public Health (Licence: ID D4811) | |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2019-05-17 |