| NPI | 1710013297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: FL DN 9764) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00009957) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2015-11-19 |