| NPI | 1528270634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: WA DE00009793) |
| Additional Taxonomies | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: WA GA10000366) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2025-08-04 |