| NPI | 1609942473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: ID D3068) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE8382) |
| 122300000X Dentist (Licence: OR D9557) | |
| Enumeration Date | 2006-11-25 |
| Last Update Date | 2015-05-18 |