| NPI | 1609854926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE00010313) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: HI DT2206) |
| 1223P0700X Dentist, Prosthodontics (Licence: WA DE00010313) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2024-06-06 |