| NPI | 1760482392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: WA DE7267) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: WA 7267) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2018-10-11 |