| NPI | 1740407105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE00010820) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D011292) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2022-04-14 |