| NPI | 1558541458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60069344) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ 7390) |
| 122300000X Dentist (Licence: OR D9779) | |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2013-08-13 |