| NPI | 1528451085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60869990) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D10964) |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2020-09-23 |