| NPI | 1649380783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60469127) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 58163) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DR20000167) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2021-03-24 |