| NPI | 1689197808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: WA 60833737) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 32798) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2020-07-30 |