| NPI | 1639553795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 60698462) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12012380A) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2016-11-18 |