| NPI | 1598327504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE61315729) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901600182) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2023-04-12 |