NPI | 1710057021 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: WA 8154) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA 8154) |
Enumeration Date | 2006-11-08 |
Last Update Date | 2023-03-07 |