| NPI | 1720174923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OH 022379) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00010637) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2012-02-03 |