| NPI | 1619263886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60127734) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 5868) |
| 122300000X Dentist (Licence: HI DT 2433) | |
| Enumeration Date | 2011-06-25 |
| Last Update Date | 2021-02-05 |